Impact of radiotracer injection latency and seizure duration on subtraction ictal SPECT co-registered to MRI (SISCOM) performance in children

Abstract

Objective: We evaluated the impact of radiotracer injection latency and post-injection seizure duration on subtraction ictal SPECT co-registered to MRI (SISCOM) test performance in identifying the epileptogenic zone (EZ) in children with drug-resistant epilepsy who had undergone a resective epilepsy surgery.

Methods: SISCOM concordance with the EZ was retrospectively reviewed to evaluate its performance in 113 children. The impact of radiotracer injection latency and post-injection seizure duration was evaluated for their predictive value of SISCOM localization accuracy.

Results: The overall sensitivity and specificity of SISCOM in identifying an EZ was 64.8% (95%CI = 50.6-77.3) and 40.7% (95%CI = 28.1-54.3). The positive likelihood ratio and diagnostic odd ratio was 1.09 (95%CI = 0.80-1.48) and 1.26 (95%CI = 0.59-2.71), respectively. Logistic regression showed that injection latency and post-injection seizure duration did not significantly predict the probability of true positive SISCOM (p-value = 0.45 and 0.29, respectively).

Conclusion: Radiotracer injection latency and post-injection seizure duration were not shown to have a statistical significant impact on SISCOM performance in identifying the EZ.

Significance: This study demonstrates that further study of factors contributing to the performance of SISCOM in EZ identification in children is needed.

Keywords: Drug-resistant epilepsy; Epilepsy surgery; Pediatric; SISCOM.